Tongue thrusts have been a big topic in my private practice. I’ve received more questions about it as a private practice SLP than almost any other area of concern.

Generally the questions are from concerned parents who are informed of the issue by a dentist or orthodontist.

Does it really matter? The quick answer is yes.

Keep reading and I’ll answer why.

Ultimately, the anatomy related to our mouths serves two functional purposes: eating and talking. Obviously both are important. Keep this in mind as you continue reading.

Sucking habits impact the resting tongue position, which ultimately impacts speech production.

The development of sucking habits, whether it’s a pacifier, finger or thumb, can happen rather easily as children transition from baby to toddler. Often the habit is comforting for the child, and as babies it helps with calming, soothing and resting. It’s the first form of self-soothing. So it isn’t all bad.

Determining When to Curb the Habit

When it becomes problematic, however, is when it’s sustained beyond when it’s developmentally appropriate. Determining that time can be confusing.

The American Academy of Pediatrics recommends discontinuing pacifier and/or thumb-sucking between ages 2-4 years old. They also recommend discontinuing the bottle between 12-24 months.

Meanwhile, the American Academy of Pediatric Dentistry recommends curbing the habit no later than the age of 3 years. This recommendation is partially based on the eruption of permanent teeth (or adult teeth).

All of these recommendations are appropriate but as a speech-language pathologist, I would argue the earlier the better. So the curbing process should begin around the same time the child is transitioned from a bottle or breast to an open cup.

The Anatomy Behind It

The oral cavity for babies is very small and filled with those padded cheeks everyone loves to pinch. There is a physiological reason: It’s designed for survival. Babies meet their nutritional needs through liquid intake–breast or bottle–using their sucking reflex. This reflex involves the tongue thrusting forward and backward during feeding.

As babies grow, the anatomy in their mouths changes, such as the eruption of teeth, the thinning of the cheeks and the maturation and elongation of anatomy in the back of the throat that is vital to breathing and swallowing. As this anatomy changes/grows, the oral cavity begins looking larger and more open. The tongue is also positioned farther back in the mouth.

When children transition from liquids to solid foods, that sucking reflex that was vital to their survival in the beginning fades and children begin chewing and consuming foods in a more adult way.

When children extend the usage of bottles for feeding and when they continue sucking their thumbs and/or pacifiers beyond that age of transition from liquids to solid foods, it reinforces that tongue-forward positioning and interferes with typical anatomical growth/change for the tongue.

Sucking Habits Interfere with Oral Development

Sustaining that forward tongue positioning is one way in which a tongue-thrust can develop. Tongue thrust not only impacts speech but it can also impact the eruption and formation of teeth.

It can lead to an open bite, alter palatal development and lead to other issues that require significant orthodontic treatment. It can also lead to orthodontic relapse, which is when the tongue essentially undoes what the braces or other orthodontic treatment fixed originally.

According to a study published in December 2016 in the European Journal of Pediatric Dentistry, children who have digit-sucking habits are more than 4 times more at risk to develop a malocculsion (this refers to the bite or up/down closure of the teeth) and more than 2 times more at risk to have a midline deviation (this refers the upper and lower teeth matching side to side).

While it may be easy to allow prolonged use of thumb or pacifier sucking because it helps us get through the day when children are young and not always agreeable, the long-term impact is significant.

The same concerns, risks and problems can result from extended use of bottle-feeding and/or sippy cups. Again, while it’s convenient to avoid the spills and allows little hands some independence in drinking, it’s better to switch to a open cup drinking earlier. A fellow SLP who specializes in feeding disorders with babies and young children wrote this piece a few years ago for the ASHA Leader: Step Away From the Sippy Cup! It’s worth the read.

If a tongue-thrust is not treated, some orthodontists will not agree to treat because of this risk for relapse.

 Stop the Sucking Habit Early

As a speech-language pathologist, I recommend beginning the curbing process earlier than the AAP and AAPD because of developmental stages of speech and language as noted by American Speech-Language-Hearing Association.

Typically, children should starting using words between 1-2 years old. It starts with one or two and then grows to a slightly larger vocabulary of about 50 words. The earliest developing sounds are p, b and m–all of which require the lips to come together.

As a child continues acquiring and using more words, they become more and more intelligible. Usually parents understand more earlier and strangers (unfamiliar listeners) understand more later. This intelligibility table by a fellow SLP provides good perspective.

In order for the intelligibility to continue improving, children need to develop a resting tongue posture that is not too far forward in their mouth. Maintaining the sucking habit continues that pattern.

So when parents ask me about whether a tongue thrust really matters–I most definitely say yes.

Addressing a tongue thrust will not only help with speech intelligibility, but it will also reduce the chances of orthodontic work being undone by the pressure of the tongue.

After all, who wants to have braces twice? Or worse yet, go through all that treatment for no change? I had braces and I don’t want to do it again.

For all those who argue it’s cute or citing that nothing happened to someone they know who sucked their thumb, I’d say the potential for problems–either with speech, public speaking confidence and/or oral development–is far too great to brush it off. Also what’s considered cute at age 3 or 4 is not at age 10 or 11 or even older.

Speech with Sara LLC offers treatment for forward tongue positions as well as for elimination of thumb/digit sucking habits. For more information, click here.

Additional Resources for this post:

Non-nutritive sucking habits and their effects on the occlusion in the deciduous dentition in children. Lopes Freire GM, Espasa Suarez de Deza JE, Rodrigues da Silva IC, Butini Oliveira L, Ustrell Torrent JM, Boj Quesada JR. Eur J Paediatr Dent. 2016 Dec;17(4):301-306.

Bowen, C. (2011). Table1: Intelligibility. Retrieved from on 9/13/2017.

Tongue Thrust? Thumb-Sucker? Why does it matter anyway?

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